PROJECT SUMMARY Despite strong evidence the human papillomavirus (HPV) vaccine is effective in preventing certain anogenital cancers, only 69% of adolescent females and 63% of males in the U.S. have initiated the series. Research has demonstrated that the leading predictor of parents? decision to vaccinate their child against HPV is a strong recommendation from physicians. Recent interventions have focused on improving physicians? recommenda- tions through education about national recommendations via presentations, webinars, electronic health record alerts, and quality improvement incentives. Despite the rigorous and innovative methods used, these studies have resulted in variable effects, perhaps, in part, because of the lack of immersive, deliberate practice of com- municating vaccine recommendations. Our research team?s long-term goal is to increase HPV vaccination rates in adolescents, which will decrease rates of HPV-associated cancers and pre-cancers. The objective of this application is to evaluate the effectiveness of a novel virtual reality intervention, Virtual Immersive Commu- nication Training on Recommending Immunizations (VICTORI), designed to enhance the strength of physi- cians? HPV vaccine recommendations through deliberate practice. We will evaluate whether VICTORI im- proves HPV vaccine initiation and completion rates among 11 to 17-year-old patients, as well as improves phy- sicians? HPV vaccine attitudes, self-efficacy, and strength of recommendation. Our hypothesis is that the imple- mentation of VICTORI will be positively associated with an increase in vaccine initiation and completion rates, and that this association will be mediated by improvements in physician attitudes, self-efficacy, and strength of recommendation. The rationale for the proposed research is that an evaluation of VICTORI will inform effective and scalable strategies to train physicians to provide strong vaccine recommendations, resulting in increased HPV vaccine rates and ultimately lower rates of HPV-associated cancers. To achieve our objective, we will ac- complish these specific aims: (1) evaluate VICTORI for acceptability and feasibility, and (2) conduct a single- site intervention assessing the efficacy of VICTORI in increasing HPV vaccine rates. The proposed research is significant because it is the first step in determining the effect of deliberate practice using virtual reality simula- tions to increase HPV vaccine initiation and completion rates. The approach is innovative because it is the first rigorous effort to develop and evaluate the efficacy of virtual reality as a training platform to teach best-practice communication skills related to HPV vaccine counseling. The expected outcome of this work is successful im- plementation of VICTORI, designed to increase strong HPV vaccination recommendations by physicians, which in turn will increase HPV vaccination rates.